this is my project paper

 

Prospectus: Diabetes Management Among Adults Sierra Leoneans in America

Problem Statement

           Diabetes remains one of the most prevalent diseases among Americans, especially among the black population, such as Sierra Leoneans living in the U.S. According to the Centers for Disease Control and Prevention (CDC, 2020), 34.2 million adult Americans have diabetes, 10.5% of the country’s population. Recent Statistics also report that 88 million individuals aged 18 years and above have prediabetes, prediabetes; a condition where glucose levels are elevated but not enough to meet diabetes criteria (CDC, 2020). This only confirms that diabetes continues to be a disease facing American healthcare providers. The CDC (2020) indicates that prevalence among the non-Hispanic black population stands at 11.7%, making blacks the third largest group in America behind American Indian/Alaska Native and Hispanic populations. In fact, in 2018, non-Hispanic blacks were 60% more likely to be diagnosed with diabetes and double the mortality rate than non-Hispanic white adults (U.S. Department of Health and Human Services Office of Minority Health, 2018). These statistics support the claim that diabetes is a significant health issue for blacks.

There are various barriers and risk factors that make cases of diabetes to be high among Blacks, such as Sierra Leoneans. A study by Chatterjee et al. (2015) revealed that lifestyle, physiological, environmental, and genetic factors associated with diabetes results in Blacks having higher incidences of diabetes than the white population. The study indicated that eating behaviors contribute to people’s increased risk of getting diabetes. Chatterjee et al. also reported that the failure of an individual to embrace a lifestyle of taking part in physical activities increases the risk of diabetes. Many of these barriers can be influenced by a person’s culture (CDC, 2022; Idriss et al., 2020).

           Culture is known to impact diabetes self-management by influencing health beliefs, customs, and diet (CDC, 2022; Idriss et al., 2020). According to Bhattacharya (2012), self-management is the most effective way of handling diabetes through engagement in physical exercise and dietary management. However, Bhattacharya (2012) indicates that culture, like that of Sierra Leoneans, hinders the ability of these diabetes management practices. The culture influences for Sierra Leoneans can stimulate negative attitudes towards insulin use, promoting nihilistic beliefs about diabetes, using spirituality to advocate for diabetes self-management activities, and favoring traditional remedies to treat and manage diabetes (Shahin et al., 2019). In fact, Shahin and colleagues state that some Sierra Leoneans believe an evil spirit is the reason for illness and will turn to a spiritual leader before seeking advice from a medical provider. Other black patients might refuse to use insulin injection to regulate blood sugar levels if their culture believes insulin use causes organ damage and severe complications among diabetic patients (Rebolledo & Arellano, 2016). This education session will provide nursing professionals with knowledge on the Sierra Leone culture and influences it can have on diabetes management. This knowledge will as allow nurses to incorporate their patients’ cultural traditions in their patients’ care plans to promote greater patient adherence to medical recommendations (Bhattacharya, 2012). 

Practice-Focused Question (s)

Will an educational program improve nursing staff knowledge of how cultural preferences influence diabetes self-management practices among Sierra Leoneans with Diabetes Mellitus?

Social Change

           The project will contribute to Walden University’s mission to promote positive social change, which is defined as, “A positive social change leads to improvement in social and human conditions, and makes the community better” (Walden University, 2021, para 1). One of the social changes brought by the project is improving the quality of life for Sierra Leonean patients with diabetes who receive medical services from an Eastern medical home health nursing agency. The project is aimed to increase the nurses’ knowledge who work at the medical home health staffing agency and care for Sierra Leonean patients in the community. This knowledge will help the nurses to encourage their patients to be an active partner in the care of their diabetes by working with patients to create diabetic self-management care plans that align with the patients’ cultural preferences.

The Context for the Doctoral Project

            The proposed setting for this doctoral project is a privately held medical staffing company headquartered in the District of Columbia which provides medical care to approximately 300 patients, of which five percent are estimated to be Sierra Leonean (B. Koroma, personal communication, June 19, 2022). The home health nursing agency employs 505 healthcare employees (46 LPNS, 24 RNs and 435 HHAs). The nurses who work at this site, despite their knowledge of diabetes management, have conveyed a need for more understanding of the cultural impact of the Sierra Leone cultural preferences on DM self-management practices.

Sources of Evidence

The diabetes problem is a significant healthcare issue in the U.S. Based on the statistics from the CDC (2020), 34.2 million adult Americans have diabetes, while 11.7% of these cases are in Black non-Hispanic communities. Cultural competence enables the nurse to efficiently and successfully understand, communicate, and interact with individuals. It focuses specifically on understanding the relationship between nurses and patients. Acquiring knowledge of diverse cultural practices and worldviews. According to Kanaan, (2008) a “significant association between improved information given by the physician, more participatory decision making, enhanced self-efficacy, healthier behaviors, and better outcomes in patients with diabetes” (p.6). Hence, there is a need to understand how diabetes can be managed for patients of Sierra Leone origin living in the U.S. to improve their quality of care and disease burden. A study published in the Journal of Diabetes & Metabolic Disorders, concluded that the following seven self-care practices help patients with diabetes avoid hospital visits and serious health complications:

Healthy eating

Being physically active

Monitoring blood sugar levels

Complying with medications

Using problem-solving skills

Developing healthy coping skills

           Practicing risk-reduction behaviors

Approach or Procedural Steps

            An educational program focused on the cultural preferences of Sierra Leonians that influence diabetes self-management practices will be provided for approximately 70 nurses who work in the staffing company. The educational intervention will follow the Walden University Doctor of Nursing Practice (DNP) Manual for Staff Education (Walden University 2021). The content for the educational intervention will be based on best practices outlined by the American Diabetes Association, The Center for Disease Control (CDC) and other published literature. Before conducting the education session, the nurse manager and other stakeholders in the staffing company will review the educational content to ensure it aligns with the organization, needs, values, and practices. The effectiveness of the educational program will be conducted by assessing the nurses’ knowledge before and after the presentation of the educational program. The assessment consists of descriptive statistics and comparative analysis to evaluate any change in the nurse’s knowledge of the cultural perspectives of Sierra Leone patients that influence diabetes self-management practices.

Ethical

            Ethical approval will be obtained from the Walden IRB prior to implementation of the project.  Participants will be asked to provide consent to participate in the voluntary education session. Although, the project will include human subjects, the nature of the project will not involve any potential risks to the subjects. All participants will be given a study number that they will use for before and after assessment of their knowledge. That number will only be known to the participant and written on the assessment form by the participant themselves. Furthermore, no other private health information (PHI) or Health Insurance Portability and Accountability Act (HIPAA) protected data will be collected during this project, that will readily identify any subjects. 

Alignment

Upon review of the Walden DNP Project resources, all aspects of the prospectus appear to align with sources of evidence supporting the practice problem and project aim. The problem aligns with the practice-focused question, “Will an educational program improve nursing staff knowledge of how cultural preferences influence diabetes self-management practices among Sierra Leoneans with Diabetes mellitus?” Also in alignment is the approach to addressing the practice problem and the associated procedural steps. The practice-focused question will ensure that appropriate information is gathered to answer the question, which will, in turn, contribute to the management of diabetes through self-management and enlightening nursing staff on diabetes management.

References

American Diabetes Association (2010). Diagnosis and classification of diabetes mellitus. Diabetes care, 33 Suppl 1(Suppl 1), S62–S69. https://doi.org/10.2337/dc10-S062

Bhattacharya, G. (2012). Self-management of type 2 diabetes among African Americans in the

Arkansas Delta: A strengths perspective in social-cultural context. Journal of Health Care for the Poor and Underserved, 23(1), 161-178. https://doi.org/10.1353/hpu.2012.0035

Centers for Disease Control and Prevention (2020). National diabetes statistics report, 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Centers for Disease Control and Prevention (2022, July 28). Diabetes and Cultural Foods. https://www.cdc.gov/diabetes/library/features/diabetes-cultural-eating.html

Chatterjee, R., Maruthur, N. M., & Edelman, D. (2015). Novel risk factors for type 2 diabetes in

African-Americans. Current Diabetes Reports, 15(12), 1-10. https://doi.org/10.1007/s11892-015-0675-5.\

Idriss, A. Diaconu, K., Zou, G., Senesi, R. G. B., Wurie, H. & Witter, S. (2020). Rural-urban health-seeking behaviors for non-communicable diseases in Sierra Leone. BMJ Glob Health, 5(2), e002024.

Kanaan, S. B. (2008, April). Promoting effective self-management approaches to improve chronic disease care: Lessons Learned. https://www.chcf.org/publication/promoting-effective-self-management-approaches-to-improve-chronic-disease-care-lessons-learned/

 

Rebolledo, J. A., & Arellano, R. (2016). Cultural Differences and Considerations When Initiating Insulin. Diabetes spectrum: a publication of the American Diabetes Association, 29(3), 185–190. https://doi.org/10.2337/diaspect.29.3.185

Shahin, W., Kennedy, G. A., & Stupans, L. (2019). The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: A systematic review. Patient Prefer Adherence, 1(13), 1019-1035.

U.S. Department of Health and Human Services Office of Minority Health (2018). 2018 National Healthcare Quality and Disparities Report | Agency for Healthcare Research and Quality. Https://www.ahrq.gov/research/findings/nhqrdr/index.html

Walden University (2021). Walden and social change. https://academicguides.waldenu.edu/social-change/mission

 

 

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